NSIDRC Journal Article Alert — November
30, 2007
Prepared by the National Sudden Infant Death Resource Center
at Georgetown University.
This journal article alert provides selected items added to
the National Library of Medicine’s PubMed database in
the last week.
Past issues of NSIDRC journal alerts are available at http://www.sidscenter.org.
Availability of full-text journal articles is usually limited
to subscribers or through inter-library loan. Please
see your local library for copies of these articles.
1: Tien JC, Tan TY.
Non-surgical interventions for threatened and recurrent miscarriages.
Singapore Med J. 2007 Dec;48(12):1074-90; quiz 1090
Yong Loo Lin School of Medicine, National University of Singapore,
10 Medical Drive, Singapore 117597.
Many surgical and non-surgical interventions are used in the
management of threatened and recurrent miscarriages. Evidence-based
management of recurrent miscarriages requires investigations
into the underlying aetiology. When a specific cause is identified,
directed treatment may reduce miscarriage rates. Combined aspirin
and heparin for antiphospholipid syndrome, and screening and
treatment of bacterial vaginosis between ten and 22 weeks of
pregnancy with clindamycin, are the only interventions proven
to be useful in randomised controlled trials (RCTs). The use
of periconceptional metformin for polycystic ovarian (PCO)
syndrome is promising, though data from RCTs are still required.
The use of heparin in inherited thrombophilias, bromocriptine
in hyperprolactinaemia and luteinising hormone suppression
in fertile patients with PCO syndrome are more controversial.
In threatened miscarriages, or when no cause is found, treatment
becomes empirical. Supportive care may reduce miscarriage rates.
Dydrogesterone, a progesterone derivative, may further reduce
miscarriage rates. Bed rest and avoidance of sexual intercourse,
though commonly advised, are of no proven benefit. Use of uterine
relaxing agents, human chorionic gonadotrophin, immunotherapy
and vitamins remain controversial in idiopathic recurrent miscarriages.
2: Fontanarosa M, Galiberti S, Fontanarosa N.
Fertility after non-surgical management of the symptomatic
first-trimester spontaneous abortion.
Minerva Ginecol. 2007 Dec;59(6):591-4.
Department of Gynecology, Perinatology and Human Reproduction,
Policlinico di Careggi, Florence, Italy nicolasfontanarosa@hotmail.com.
AIM: The aim of this study was to assess clinical outcome
after a non-surgical management of the symptomatic spontaneous
abortion in the first-trimester of pregnancy in a level III
maternity hospital and to assess the subsequent fertility of
the study population. METHODS: A prospective study in which
70 women with a symptomatic early pregnancy loss undergone
an expectant management of miscarriage was performed. If resolution
was not obtained after 4 days, medical treatment with misoprostol
was administered. The patients were followed-up after the first
menstrual cycle with a medical examination and an ultrasound
scan. After 12 months, the patients were interviewed by phone
to investigate on possible complications of abortion and on
the occurrence of new pregnancies. RESULTS: The non-surgical
management of miscarriage was successful in 68 out of 70 women
(97%). Surgical intervention was necessary in 2 of 70 women
(3%). Bleeding and pain were described as slightly more than
a normal menstrual cycle. Among the 60 patients that answered
at the 12-month follow-up (85.7%), none reported gynecological
troubles and the subsequent pregnancy rate of the women was
81%. CONCLUSION: Expectant management of selected cases of
spontaneous abortion, associated to medical treatment in indicated
cases, could offer a valid alternative to dilatation and curettage.
3: Gilliland MG, Levin AV, Enzenauer RW, Smith C, Parsons
MA, Rorke-Adams LB, Lauridson JR, La Roche GR, Christmann LM,
Mian M, Jentzen J, Simons KB, Morad Y, Alexander R, Jenny C,
Wygnanski-Jaffe T.
Guidelines for Postmortem Protocol for Ocular Investigation
of Sudden Unexplained Infant Death and Suspected Physical Child
Abuse.
Am J Forensic Med Pathol. 2007 Dec;28(4):323-329.
From the Department of Pathology and Laboratory Medicine,
The Brody
School of Medicine at East Carolina University, Greenville,
North Carolina; Department of Ophthalmology and Vision Science,
Department of Paediatrics, Suspected Child Abuse and Neglect
(SCAN) Program, Department of Laboratory Medicine and
Pathobiology, The Hospital for Sick Children, University of
Toronto, Toronto, Canada; Department of Ophthalmology,
University of Tennessee Health Science Center, Memphis, Tennessee;
Ophthalmic Sciences Unit, University of Sheffield, United
Kingdom; Department of Pathology, The Children's Hospital
of Philadelphia, Philadelphia, Pennsylvania; Graphics, Montgomery,
Alabama; Department of Ophthalmology, Dalhousie University
and the IWK Health Centre, Halifax, Nova Scotia, Canada; Montreal
Children?s Hospital and McGill University Health Centre, Montreal,
Quebec, Canada; Department of Pathology, Medical
College of Wisconsin, Milwaukee, Wisconsin; Assaf Harofeh
Medical Center, Tel Aviv University, Zrifin, Israel; University
of Florida, Gainesville, Florida; and Morehouse School of Medicine,
Atlanta, Georgia; Brown Medical School, Providence, Rhode
Island; and Sheba Medical Center, Tel Hhashomer, Tel Aviv
University, Ramat-Gan, Israel.
Postmortem examination is a cornerstone in identifying the
cause of unexplained sudden death in children. Even in cases
of suspected or known abuse, an autopsy may help characterize
the nature of the abuse, which is particularly important in
the forensic autopsy of children in the first 3 to 4 years
of life when inflicted neurotrauma is most common. Forensic
examinations are vital in cases that might otherwise be diagnosed
as sudden infant death syndrome. The ocular autopsy in particular
may demonstrate findings that were not appreciated on antemortem
clinical examination. This protocol for postmortem examination
of the eyes and orbits was developed to promote more consistent
documentation of findings, improved clinical and forensic decision
making, and more replicable and coherent research outcomes.
4: Jenkins RO, Sherburn RE
Used cot mattresses as potential reservoirs of bacterial infection:
nutrient availability within polyurethane foam.
J Appl Microbiol. 2007 Nov 26; [Epub ahead of print]
School of Allied Health Sciences, De Montfort University,
The Gateway, Leicester, UK.
Aim: To evaluate possible source of nutrients for bacterial
growth within polyurethane (PU) foam of used cot mattresses
as determinants of bacterial population density. Methods and
Results: Used infant mattresses (n = 30) were analysed for
bacteria capable of degrading colloidal PU and for aqueous
soluble chemical components (aromatic amines, ammonium ions,
phosphates and protein). Mattress type (waterproof cover vs
exposed PU foam at the infant-head region), mattress age and
previous use by another child were evaluated as factors that
could influence the measured parameters. The levels of protein
extracted from PU foam were (i) significantly (P = 0.0019)
higher for mattresses lacking a waterproof cover at the infant-head
region and (ii) positively correlated with both culturable
bacterial population densities of the PU foams and extent of
growth of Staphylococcus aureus on aqueous leachates. No statistically
significant (P > 0.05) associations between other measured
parameters and mattress type/use factors were identified. Conclusions:
Infant use of cot mattresses with exposed PU foam leads to
accumulation of proteins within the PU, which can promote bacterial
growth. Significance and Impact of the Study: The study provides
a mechanistic explanation for increased levels of bacteria
associated with exposed PU of cot mattresses. In the context
of the common bacterial toxins hypothesis for the sudden infant
death syndrome (SIDS), this could explain the lowered risk
of SIDS associated with use of a waterproof cover above the
mattress.
5: Szekeres-Bartho J, Balasch J.
Progestagen therapy for recurrent miscarriage.
Hum Reprod Update. 2007 Nov 22; [Epub ahead of print]
Department of Medical Microbiology and Immunology, Medical
School, Pecs University, H-7643 Pecs, Hungary.
BACKGROUND Recurrent pregnancy loss (RM) affects 0.5-1% of
couples. The pathophysiology of RM is complex. The suggested
causes include anatomical, genetic and molecular abnormalities,
endocrine disorders, thrombophilias and anti-phospholipid syndrome.
In approximately 50% of the cases neither of the above can
be identified. We aimed at examining the evidence on the role
of progesterone in the pathophysiology of RM, and the clinical
evidence on effectiveness of progestogen treatment. METHODS
We searched PubMed and the Cochrane database covering the period
of 1968-2007. The search terms progestogens and recurrent miscarriage,
NK cells and recurrent miscarriage as well as cytokines and
recurrent miscarriage were used. RESULTS Progesterone is indispensable
for creating a suitable endometrial environment for implantation.
RM may be due to subnormal progesterone secretion and retarded
endometrial development in the peri-implantation period. Progesterone
also acts on the immune system, mainly by affecting cytokine
synthesis and the function of NK cells. A recent meta-analysis
showed that though progesterone treatment did not affect pregnancy
outcome in women with miscarriages in general, separate analysis
of three small and dated studies including altogether 91 patients
with RM revealed a small but significant effect. It is noteworthy
that the design of these 40 years old studies does not meet
modern requirements. CONCLUSION Standardized laboratory protocols
for identifying potential targets of progestogen treatment
as well as implementation of well-designed randomized studies
are needed to establish the usefulness of progesterone supplementation
in the treatment of RM.
6: Lash GE, Quenby S, Burton GJ, Nakashima A, Kamat BR, Ray
J, Bulmer JN.
Gestational Diseases: A Workshop Report.
Placenta. 2007 Nov 21; [Epub ahead of print]
Uterine Cell Signalling Group, Institute of Cellular Medicine,
3rd Floor, William Leech Building, Newcastle University, Newcastle
upon Tyne NE2 4HH, UK.
Between 11% and 20% of all clinically recognised pregnancies
are lost before the 20th week of gestation, with huge financial
and personal implications. Immune mechanisms have been proposed
to play a role in unexplained recurrent miscarriage. Considerable
attention has focused on endometrial leucocyte populations
in recurrent miscarriage, although the underlying pathogenesis
remains largely unexplained. The mechanisms underlying sporadic
miscarriage are even less well understood, although aneuploidy
is the commonest attributable cause of early (</=12 completed
weeks gestation) sporadic miscarriage. Hydatidiform mole is
a rare cause of early pregnancy loss with marked geographical
variation in incidence. Both complete and partial hydatidiform
mole are associated with excessive trophoblast proliferation
and hence provide an opportunity to study trophoblast growth
regulation.
7: Matturri L, Ottaviani G, Lavezzi AM.
Guidelines for neuropathologic diagnostics of perinatal unexpected
loss and sudden infant death syndrome (SIDS)-a technical
protocol.
Virchows Arch. 2007 Nov 22; [Epub ahead of print]
Institute of Pathology, University of Milan, Via della Commenda,
19, 20122, Milan, Italy, luigi.matturri@unimi.it.
In light of the growing information on the pathophysiology
and clinical aspects of unexpected perinatal loss and sudden
infant death syndrome (SIDS), a novel approach to the inherent
problems by pathologists has become necessary. Herein, we propose
an up-to-date protocol for accurate examination of the central
autonomic nervous system and of the cardiac conduction system,
which can encompass morphological and/or functional abnormalities
of reliable epicritical value in unexplained perinatal loss
and SIDS, particularly in those cases (still quite numerous)
lacking adequate clinical documentation. Anatomo-pathologic
examination of the central autonomic nervous system includes
an in-depth study on histological serial sections of the brainstem,
cerebellum, and spinal cord, where the main structures participating
in control of the vital functions are located. For the histological
study of the cardiac conductions system, serial sections were
obtained from two blocks, including the sino-atrial node and
the atrio-ventricular system, respectively. This type of updated
investigation is yielding important arguments for a broader
discussion of the pathogenesis of unexpected stillbirth, early
neonatal death, and SIDS, besides allowing a more complete
forensic-medical documentation of individual cases.
8: Lavezzi AM, Matturri L.
Functional neuroanatomy of the human pre-Bötzinger complex
with particular reference to sudden unexplained perinatal and
infant death.
Neuropathology. 2007 Nov 20; [Epub ahead of print]
Institute of Pathology, Lino Rossi Research Center, University
of Milan, Milan, Italy.
The authors are the first to identify in man the pre-Bötzinger
complex, a structure of the brainstem critical for respiratory
rhythmogenesis, previously investigated only in rats. The evaluation
of the neurokinin 1 receptors and somatostatin immunoreactivity
in a total of 63 brains from 25 fetuses, nine newborns and
29 infants, allowed to delineate the anatomic structure and
the boundaries of this human neural center in a restricted
area of the ventrolateral medulla at the obex level, ventral
to the semicompact ambiguus nucleus. The neurons of the pre-Bötzinger
complex were roundish in fetuses before 30 gestational weeks
and lengthened after birth, embedded in a dendritic system
belonging to the reticular formation. Besides, structural and/or
functional alterations of the pre-Bötzinger complex were
present in a high percentage of sudden deaths (47%), prevalent
in late fetal deaths. In particular, different developmental
defects (hypoplasia with a decreased neuronal number and/or
dendritic hypodevelopment of the reticular formation, abnormal
neuronal morphology, immunonegativity of neurotransmitters,
and agenesis) were found. The authors suggest that the pre-Bötzinger
complex contains a variety of neurons not only involved in
respiratory rhythm generation, but more extensively, essential
to the control of all vital functions. Sudden death and in
particular sudden unexpected fetal death could therefore be
ascribed to a selective process when developmental alterations
of the pre-Bötzinger complex arise.
Prepared by the
National Sudden Infant Death Resource Center
Georgetown University
2115 Wisconsin Avenue, N.W., Suite 601
Washington, DC 20007
(866) 866-7437 toll free
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(202) 784-9777 fax
info@sidscenter.org
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